Trends of Pediatric Dental Rehabilitation Using General Anesthesia by Service Location During the COVID-19 Public Health Emergency, 2019 to 2021.

Purpose: The purpose of this study was to investigate the trends of pediatric dental rehabilitation in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs) during the COVID-19 public health emergency (PHE) from 2019 to 2021 across states and demographic groups. Methods: This cross-sectional study utilized the 2019 to 2021 Transformed Medicaid Statistical Information System Analytical Files to examine trends in dental rehabilitation for children ages 12 years and younger enrolled in Medicaid or the Children's Health Insurance Program. The final analytic sample included 20,508,093 beneficiaries from 2019, 19,436,957 beneficiaries from 2020, and 20,416,440 beneficiaries from 2021. Chi-square tests were used to compare dental rehabilitation usage across groups (age, sex, race/ethnicity, and place of service). Results: Rehabilitation of Medicaid beneficiaries performed in HOPDs showed a decrease year over year (51 to 34 to 30; P<0.001), while the usage in ASCs increased (1,307 to 1,310 to 1,367; P<0.001). For all three years, the highest usage was seen in Non-Hispanic (NH) American Indian/Alaskan Native children (154, 66, 74; P<0.001), while the lowest usage was seen in NH Black children (21, 16, 17; P<0.001). Rehabilitation for Hispanic children had the greatest relative recovery over the three years (39 to 34 to 38; P<0.001). Conclusions: Dental rehabilitation usage in ambulatory surgery centers showed continued growth through the public health emergency. There was significant variation in rates across states and demographics.

Dental Trauma in Children with Autistic Disorder: A Retrospective Study.

BACKGROUND: The oral health care of autistic children is elaborated; they often fail to define dental problems, and a family-centered approach can be useful to improve and intercept these disorders. AIM: To assess the oral status of autistic children, comparing it with no autistic patients. MATERIALS AND METHODS: A retrospective study analyzed the oral health status of 70 children, 35 with autism and 35 without the disorder. Conditions assessed were dental trauma type, periodontal tissue injuries, soft tissue lip injuries, different treatments carried out, associated soft tissue findings and disorders, and the long-term management. All patients (≤15 years of age) were chosen consecutively. RESULTS: Females (57%) suffered more traumatic injuries than males (43%) in the autistic group, whereas males affected by dental trauma (54%) are predominant in the control group. The enamel fracture was the main finding among the dental trauma types in both groups followed by enamel/dentin/pulp fracture (31%), root fracture (11%), and avulsions (3%) in the autistic group and by avulsions (20%), root fracture (11%), and enamel/dentin/pulp fracture (6%) in the control group. The comparison of all variables of the two groups showed a statistically significant difference (P < 0.012). The lower lip was statistically more injured than the upper lip (P < 0.005). CONCLUSIONS: The composite restorative technique was the most common approach carried out; the long-term evaluation, when possible, was predominantly managed through root canal therapy in the control group (81%), and root canal therapy (50%) and tooth extraction (50%) in the sample group.

Socio-environmental determinants of the delay in the first dental visit: results of two population-based cohort studies in Brazil

The objective of this study was to describe the timing of the first dental visit and investigate the association of socioeconomic and behavioral factors with dental visit delay among 10/11-year-old children from two live-birth population cohorts with extremely contrasting socioeconomic profiles. Follow-up data (2004-2005) from cohorts of Ribeirão Preto (RP) (n=790) and São Luís (SL) (n=673) were evaluated. Delay in dental visit was defined as not visiting a dentist before the age of 7. Covariates included family socioeconomic characteristics, mother-related health behavior, and child-related characteristics. Prevalence ratios with robust standard errors were estimated. In both cohorts, less than 5% of children had visited a dentist before the age of two and about 35% of them had not visited a dentist before the age of seven. Lower mother's schooling and lack of private health insurance were associated with the delay in first dental visit for both cohorts. A small number of mother's prenatal care visits and being from a single-father family or a family without parents were only associated in the RP cohort, while having ≥4 siblings and lifetime dental pain were associated in the SL cohort. The association with dental pain probably reveals a preventive care-seeking behavior. Therefore, the percentage of delayed first dental visit of children was very high even among those with the most educated mothers. Further studies are necessary to analyze recent changes and underlying factors related to access to first dental visit after the implementation of the National Oral Health Policy in 2006.

Socio-environmental determinants of the delay in the first dental visit: results of two population-based cohort studies in Brazil.

The objective of this study was to describe the timing of the first dental visit and investigate the association of socioeconomic and behavioral factors with dental visit delay among 10/11-year-old children from two live-birth population cohorts with extremely contrasting socioeconomic profiles. Follow-up data (2004-2005) from cohorts of Ribeirão Preto (RP) (n=790) and São Luís (SL) (n=673) were evaluated. Delay in dental visit was defined as not visiting a dentist before the age of 7. Covariates included family socioeconomic characteristics, mother-related health behavior, and child-related characteristics. Prevalence ratios with robust standard errors were estimated. In both cohorts, less than 5% of children had visited a dentist before the age of two and about 35% of them had not visited a dentist before the age of seven. Lower mother's schooling and lack of private health insurance were associated with the delay in first dental visit for both cohorts. A small number of mother's prenatal care visits and being from a single-father family or a family without parents were only associated in the RP cohort, while having ≥4 siblings and lifetime dental pain were associated in the SL cohort. The association with dental pain probably reveals a preventive care-seeking behavior. Therefore, the percentage of delayed first dental visit of children was very high even among those with the most educated mothers. Further studies are necessary to analyze recent changes and underlying factors related to access to first dental visit after the implementation of the National Oral Health Policy in 2006.

Usage of Behavior Guidance Techniques Differs by Provider and Practice Characteristics.

PURPOSE: The purpose of this study was to determine provider and practice characteristics influencing usage of behavior guidance techniques (BGTs). METHODS: A 24-item survey was emailed to 4,117 active AAPD members to identify factors influencing pediatric dentists' use of BGTs. RESULTS: A total of 1,081 surveys were returned, for a 26 percent response rate. The mean age of respondents was 44.7 years old, with recent graduates comprising the largest group (30.5 percent). Usage of voice control, nitrous oxide, sedation, and general anesthesia (GA) differed significantly, according to experience. Respondents with at least 30 years of experience reported changes in usage. Tell-show-do, nitrous oxide, oral sedation, and passive restraint were significantly more frequent among female respondents. Parental absence, oral sedation, and GA were significantly more frequent in respondents serving low income populations. Parental absence, pharmacologic techniques, and restraint were significantly different in frequencies among the different geographic regions. CONCLUSIONS: Usage of behavior guidance techniques has changed over the past three decades, with more recent graduates and experienced practitioners now emphasizing pharmacologic techniques. More assertive behavior guidance techniques are used more frequently by experienced providers and those in practices in the southwest or serving lower income populations. Pharmacologic techniques are used at a higher prevalence by recent graduates and providers who are female or serving lower income populations.

Are U.S. Dentists Adequately Trained to Care for Children?

For decades, dental educators have noted changes in predoctoral dental education in pediatric dentistry, beginning with shifts in patients' characteristics and their availability for dental schools. During the same period, national data exposed a lingering dental caries epidemic in U.S. children yet reported more treatment of young poor children. The professional literature suggests a reluctance of the general dental community to care for children, particularly the very young who would most benefit from a dental home. The purpose of this commentary was to weigh evidence of several decades of studies on this seeming contradiction and provide the perspectives of dental students in training, those seeking advanced pediatric dentistry education or providing it, and end-users of our educational system who employ U.S. dental graduates to care for children. The usefulness of dental education establishment indicators is also reviewed, and recommendations for improvement are proposed.

Recall intervals and time used for examination and prevention by dentists in child dental care in Denmark, Iceland, Norway and Sweden in 1996 and 2014.

OBJECTIVE: The purpose of the present study was to explore intervals between regular dental examination and the time dentists spent for examination and preventive dental care of children in 1996 and 2014. PARTICIPANTS AND METHODS: In Denmark, Norway and Sweden, random samples of dentists working with children were included, while in Iceland all dentists were mailed questionnaires. Complete information was provided by 1082 of 1834 dentists (64%) in 1996 and 1366 of 2334 dentists (59%) in 2014. Results were assessed using chi-square and analysis of variance with post-hoc tests. RESULTS: Some trends were consistent in all countries, but considerable differences in routines between the countries persisted during the period. The most used and maximum planned recall intervals were on average 14.8 (sd 4.8) and 18.5 (sd 4.6) months in 2014, respectively 3.1 and 3.5 months longer than in 1996 (p⟨0.05). In 2014 dentists used ample time delivering preventive care to children. Dentists reported spending significantly more time providing preventive care for caries risk children than for other children both in 1996 and 2014. Concurrent with extended intervals, dentists reported spending longer performing routine examinations in three of the four countries in 2014 than in 1996. CONCLUSIONS: This study of trends in dental care delivered by dentists during recent decades showed moves towards extended recall intervals and preventive care individualized according to caries risk. In addition, extending intervals could necessitate more time for a routine dental examination.

Could Video Glasses Contribute to Behaviour Management in the 21st Century?

Dental fear in the paediatric population can be a significant barrier to providing optimal dental care. Pharmacological management techniques utilized to manage anxiety, such as conscious sedation and general anaesthesia, are expensive and require specialized equipment with additional staff training. With recent advances in technology, video glasses are an economic and novel distraction technique that may aid in improving behaviour management and facilitate dental treatment. Clinical relevance: Nervous children may find difficulty in accessing care owing to their inability to co-operate and accept dental treatment. This paper describes an innovative technique that may aid the clinician in overcoming this barrier.

The Effect of Oral Dexmedetomidine Premedication on Preoperative Cooperation and Emergence Delirium in Children Undergoing Dental Procedures.

INTRODUCTION: The aim of this study was to detect the effect of 1 µg/kg of oral dexmedetomidine (DEX) as premedication among children undergoing dental procedures. MATERIALS AND METHODS: The study involved 100 children between 2 and 6 years of age, ASA I, who underwent full-mouth dental rehabilitation. The DEX group (n = 50) received 1 µg/kg DEX in apple juice, and the control group (n = 50) received only apple juice. The patients' scores on the Ramsay Sedation Scale (RSS), parental separation anxiety scale, mask acceptance scale, and pediatric anesthesia emergence delirium scale (PAEDS) and hemodynamic parameters were recorded. The data were analyzed using chi-square test, Fisher's exact test, Student's t-test, and analysis of variance in SPSS. RESULTS: RSS scores were significantly higher in the DEX group than group C at 15, 30, and 45 min (p < 0.05). More children (68% easy separation, 74% satisfactory mask acceptance) in the DEX group showed satisfactory ease of parental separation and mask acceptance behavior (p < 0.05). There was no significant difference in the PAEDS scores and mean hemodynamic parameters of both groups. CONCLUSIONS: Oral DEX administered at 1 µg/kg provided satisfactory sedation levels, ease of parental separation, and mask acceptance in children but was not effective in preventing emergence delirium. The trial was registered (Protocol Registration Receipt NCT03174678) at clinicaltrials.gov.

Pediatric Dental-Focused Interprofessional Interventions: Rethinking Early Childhood Oral Health Management.

Evidence of effectiveness for prevention of early childhood caries suggests that parent engagement needs to occur perinatally and that unconventional providers, helping professionals like social workers and dietitians and lay health workers like community health workers, are most effective. This finding, coupled with the emergence of population-based accountable care, value-based purchasing with global payments, understanding of common risk factors for multiple conditions, and social determinants of health behaviors, calls for a rethinking of early childhood oral health care. A population-based model that incorporates unconventional providers is suggested together with research needed to achieve caries reductions in at-risk families.

SPECIAL FEATURE. PEDIATRIC DENTISTRY.

There are approximately 2 million children living in the state of Michigan who will receive dental care with one of more than 5,500 MDA member dentists. Of these 5,500 MDA members, only approximately 100 are pediatric dentists.(1-3) Thus, it's safe to say that most children will find their dental homes in general dental offices. These general dentists will be providing preventive, diagnostic, and restorative care to most children under most circumstances. And with that in mind, it's of great importance that all dentists be comfortable providing high quality care to the majority of children, referring only a select group for care by a pediatric dentist.

DENTEX: The emergence of dental therapists in the United States.

Dental therapists were introduced into Alaska in 2005 to meet the basic oral health needs of Alaska Native communities. Deployed in 54 countries, dental therapists are well distributed throughout their respective societies. In Alaska, they provide effective, quality, and safe care for children in an economical manner and are generally accepted both by the public and by the dental profession. Dental therapists are increasingly employed in other states. Historical parallels exist between the physician assistant movement and dental therapists in the United States.

Ten-year trends in the health of young children in California: 2003 to 2011-2012.

This policy brief presents 10-year trends in several key health and wellness indicators for children ages 0-5 in California. These indicators are health insurance coverage; source of medical care; dental visits; overweight-for-age; parents singing and reading to their child and going out with the child; and preschool attendance. The data are from the California Health Interview Survey (CHIS), the largest state health survey in the U.S. The survey gathers information on a range of health behaviors and health conditions, as well as on access to health care among children, adolescents, and adults in California. A number of these key indicators are compared by income and by racial/ethnic group. This policy brief covers the years 2003 to 2011-2012, a period in which public health efforts for children focused on childhood obesity and improved nutrition, access to low-cost and free dental services, and the expansion of children's health insurance programs. CHIS data show improvement in health insurance coverage and access to dental services for low-income children over the 10-year period. However, the percentage of children who were overweight for their age remained unchanged among those in households with incomes below 200 percent of the federal poverty level (FPL). In terms of measures associated with school readiness, preschool attendance dropped overall between 2003 and 2011-2012, but the proportions of parents who sang, read, and went out with their children every day increased significantly during the 10-year period.